Should PCMH accreditation be the next step in your quest for high-quality care delivery?
|
|
- Nicholas Cecil Leonard
- 5 years ago
- Views:
Transcription
1 This Web version may be reproduced for individual use. Should PCMH accreditation be the next step in your quest for high-quality care delivery? Lessons learned from one organization that achieved PCMH accreditation from all four accreditation organizations and reaped the rewards. Executive View Summer MGMA. All rights reserved. By Susan Schooleman 18
2 Executive View The results of becoming one of the nation s first patient-centered medical homes (PCMHs) included the development of an electronic patient management system with chronic disease management and clinic decision support tools, population management with data analytics, active patient monitoring, higher rates of patient engagement and improved practice earnings for Southeast Texas Medical Associates (SETMA), Beaumont, Texas. Fourteen years ago the organization began defining and deploying principles and capabilities that would in 2010 lead SETMA to be recognized as a PCMH. Today, SETMA, which employs 40 providers in six clinics, has achieved PCMH accreditation from all four accrediting bodies. About 38% of SETMA s total patient population has income below the poverty level. Of those, 95% have multiple chronic conditions that need to be managed and monitored. Patients with multiple chronic conditions are the ideal beneficiaries of PCMHs, according to a comparison of the four accreditation programs. (See sidebar, page 22.) James L. Holly, MD, chief executive officer, SETMA, credits the PCMH approach for increasing SETMA s quality of care as documented through better patient outcomes and generating enough revenue to fund its not-for-profit foundation, which provides care for patients who cannot afford it. We spend almost $192,000 a month on unreimbursed services to our patients, and annually SETMA s 12 partners give a half million dollars to the foundation, says Holly, who is also an adjunct professor of family and community Medicine at the University of Texas Health Science Center, San Antonio. The very fact that we re able to do that that s $2.5 million a year shows that obviously, the return on investment from operating as a PCMH is good. The goal to become a PCMH started evolving when SETMA s three founding partners (including Holly) attended the MGMA 1997 Annual Conference and sat in on a session about EHRs. After selecting and deploying an EHR the team determined about a year later that it was too expensive and hard to use if all they could do was document a patient encounter electronically. Immediately, we changed our goal from EHR usage to electronic patient management. We began building disease management tools, clinical decision support tools, and creating the ability to make the healthcare process easier, Holly says. Passing the baton Because the EHR allowed SETMA to manage the health conditions of its patients following and actively engaging them SETMA developed a new care delivery model with the following five steps: Tracking more than 300 quality metrics on each patient Auditing panels and populations of patients for provider compliance Analyzing patient outcomes to find points of leverage for performance improvement Public reporting by provider name and performance Developing quality improvement initiatives The link between the patient encounter and the patient s year-long care is what Holly calls passing the baton. Before it was instituted, a patient presented with a chief complaint a few times a year, and the provider reacted to it. With SETMA s new approach, providers 19
3 Should PCMH accreditation be the next step in your quest for high-quality care delivery? (continued from page 19) 20 pass the baton to the patients, asking them to improve their health by making better choices year-round. Holly explains the importance of passing the baton to the patient this way: Every year has 8,760 hours, and in extreme cases, a patient who requires a lot of care might spend about 20 hours in a provider s office. This means that the patient is responsible for his or her care 8,740 hours a year. Without the activation and engagement of the patient, who takes the baton (an action that is formalized with shared decision-making), a patient s plan of care and treatment plan will fail, Holly says. This makes it clear that the patient is responsible for the overwhelming amount of his or her own care, which includes adherence with formal healthcare initiatives and with lifestyle choices that support health, he says. To support patients, SETMA monitors them and reaches out by phone or to check in. For example, using data from the EHR, SETMA professionals noticed that, on average, patients hemoglobin A1c (HgbA1c) rates were steadily improving. But the data revealed one subset of patients whose numbers were not improving. By analyzing the standard deviation of the HgbA1c, we were able to reach out to patients whose values fell far from the average of the rest of the clinic, Holly says. The outreach worked, and providers were able to take the steps needed to ensure the subset s results coincided more closely with SETMA s general patient population. SETMA uses the same EHR in all of its clinics as well as its affiliated hospitals, nursing homes and hospices. Everywhere we see patients, we re tracking them in the same database. So the continuity of care based on data is perfect, Holly adds. This process allows SETMA to improve its care delivery. For example, We ve discharged 21,000 patients from the hospital over the last five years, and 98.7% of the time, their hospital care summaries and post-hospital plans of care and treatment plans have been completed at the time they leave the hospital, Holly says. That s a record no one can match. And that has made a huge difference, not only in quality of care but also in preventable readmissions and the things we continue to be able to do. This type of process reengineering was made possible because of SETMA s commitment to the PCMH, he adds. No payer reimbursement for PCMH SETMA does not receive higher reimbursement because PCMH accreditations, but it does receive
4 Executive View a very small amount of compensation through the National Committee for Quality Assurance (NCQA) Bridges to Excellence program, 1 which rewards providers for quality care. We get paid for diabetes and heart/stroke treatment due to the quality of our treatment, Holly says. These payments represent of our total collections, or %, he adds. [Read more about payer-specific value-based programs: mgma.org/payerspecialissue.] Functioning as a PCMH has also reduced costs and increased quality for Medicare Advantage patients, who generally are poor, have multiple health conditions and require more resources to manage, Holly says. About 40% of SETMA s patients are covered by Medicare Advantage (MA). SETMA has known since 1996 that its treatment of MA recipients is less costly compared with other provider groups. In 2011, Centers for Medicare & Medicaid (CMS) hired a nonprofit research organization to compare SETMA and other medical home practices with noncoordinated practices. SETMA treatment of fee-for-service Medicare patients was 37.4% less costly than the Medicare fee-for-service practice that it was benchmarked against. Holly recommends the following steps for any practice that plans to become a PCMH: Pursue and achieve NCQA Tier 3 recognition for PCMH and deploy the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH program. Our caution would be for an organization not to assume that this achievement is the end of the medical home pilgrimage, but that it is a good beginning, Holly says. Choose another accreditation body to evaluate the practice. This provides assurances that the practice s safety and quality measures required to achieve continuous quality improvement are in place, he says. Seek a practice culture assessment for maximum transformative purposes in patient-centered care from Planetree, an international organization in Derby, Conn. In our judgment, any accreditation process should be educational as well as evaluational, Holly says. So it is with [these] accreditations; you will learn more and more about yourself from each of these. The process within itself contributes to practice transformation. Contact Susan Schooleman at sschooleman@mgma.org. PCMH accreditation services SETMA received accreditation from all four PCMH accreditation organizations: Accreditation Association for Ambulatory Health Care (AAAHC) The Joint Commission NCQA URAC (formerly the Utilization Review Accreditation Commission) Note: 1. ncqa.org/programs/recognition/bridgestoexcellence.aspx 21
5 Should PCMH accreditation be the next step in your quest for high-quality care delivery? (continued from page 21) A comparison of PCMH accreditation programs Practices that become accredited as a patient-centered medical home (PCMH) should expect to receive increased reimbursement in the future for the care coordination and care management of their most chronic and costly patients, says David N. Gans, MSHA, FACMPE, senior fellow, MGMA Professional Development & External Relations, who recently compared the four PCMH accreditation organizations in A Comparison of the National Patient-Centered Medical Home Accreditation and Recognition Programs (mgma.org/store/iteme8789). Some payers, including Michigan Blue Cross and Blue Shield, have increased reimbursement to PCMH-accredited practices to reward care management, Gans says. He believes this practice will spread. As an example, Gans points out that last December s 2014 Medicare Physician Fee Schedule Final Rule 1 (mgma.org/feeschedule) describes that in 2015 the Centers for Medicare & Medicaid (CMS) plans to establish a separate payment for qualified practices that provide chronic care management services to patients with multiple chronic conditions. In the PCMH report, Gans compares the following industrywide-accepted PCMH accreditation organizations: Accreditation Association for Ambulatory Health Care (AAAHC): 2013 Medical Home Accreditation Standards and 2013 Medical Home Certification Standards The Joint Commission: Primary Care Medical Home 2013 and 2014 Standards and Elements of Performance National Committee for Quality Assurance (NCQA): Standards for Patient-Centered Medical Home (PCMH) 2011 and 2014 Standards URAC (formerly the Utilization Review Accreditation Commission): 2013 Patient-Centered Medical Home Practice (PCMH) Certification Standard V1.1 Operating as a PCMH will have the most benefit for practices that treat patients with multiple conditions that need to be monitored, Gans says. 22 If your practice has a majority of patients who are healthy, a PCMH will create a better patient experience and improve access, but will probably have no effect on your total patient healthcare costs. In fact, it might even raise the cost of healthcare because your patients are receiving more services from you, he says. It s those patients who have multiple chronic diseases your highest acuity patients they re the ones who might offer cost savings because a PCMH keeps them out of the emergency department and out of the hospital. [Read more about population health approaches: mgma.org/pcmh.] Although comparable, the PCMH accreditation processes vary, Gans adds. The NCQA conducts a self-attestation with documentation. In other words, you submit a number of documents and attest that you do this. In contrast, URAC, AAAHC and Joint Commission use an on-site surveyor to assess the practice and make sure that it complies with their standards. Gans suggests seeking PCMH accreditation by any of the organizations that have already accredited practices in another area. For example, if an ambulatory surgery center already received AAAHC accreditation, it should consider using AAAHC for PCMH accreditation. Look at each of the programs [and] identify which one s going to best meet your needs, Gans advises. Download the report:mgma.org/store/iteme8789. Note: 1. NPRM Final Rule, U.S. Dept. of Labor, Federal Register Dec. 10;78(237):
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws.
Disclaimer This webinar may be recorded. This webinar presents a sampling of best practices and overviews, generalities, and some laws. This should not be used as legal advice. Itentive recognizes that
More informationproducing an ROI with a PCMH
REPRINT April 2016 Emma Mandell Gray Rachel Aronovich healthcare financial management association hfma.org producing an ROI with a PCMH Patient-centered medical homes can deliver high-quality care and
More informationPearls In Internal Medicine
Pearls In Internal Medicine Transitioning From Solo or Small Group Practice to a Large Group James L. Holly, MD Adjunct Professor University of Texas Health Science Center San Antonio School of Medicine
More informationState Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013
State Medicaid Directors Driving Innovation: Continuous Quality Improvement February 25, 2013 The National Association of Medicaid Directors (NAMD) is engaging states in shared learning on how Medicaid
More informationThe Patient Centered Medical Home: 2011 Status and Needs Study
The Patient Centered Medical Home: 2011 Status and Needs Study Reestablishing Primary Care in an Evolving Healthcare Marketplace REPORT COVER (This is the cover page so we need to use the cover Debbie
More informationThe Nature of Knowledge
The Importance of Data Analytics in Physician Practice Massachusetts Medical Society March 30, 2012 James L. Holly, MD CEO, SETMA, LLP www.setma.com Adjunct Professor Department of Family and Community
More informationThe MetroHealth System
The MetroHealth System June 16, 2016 Presentation to Ohio Joint Medicaid Oversight Committee Dr. James Misak, Vice Chair of Community and Population Health, Department of Family Medicine Susan Mego, Executive
More informationThe Patient Centered Medical Home Guidelines: A Tool to Compare National Programs
The Patient Centered Medical Home Guidelines: A Tool to Compare National Programs Medical Group Management Association (MGMA ) publications are intended to provide current and accurate information and
More informationMEDICAL HOMES Arkansas Hospital Association
MEDICAL HOMES Arkansas Hospital Association Framing our discussion Environmental snapshot of health care Hospitals and the PCMH Arkansas Medical Homes Patients/Consumers 2 1 Health Policy is changing Budget
More informationPayment Reform Strategies. Ann Thomas Burnett BlueCross BlueShield of South Carolina
Payment Reform Strategies Ann Thomas Burnett BlueCross BlueShield of South Carolina Disclosure I have no relevant financial relationships with commercial interests to disclose. The Current Market Landscape
More informationHealth Information Technology
ACO Congress Oct 25, 2010 Los Angeles, CA Patient Centered Medical Home and Accountable Care Organizations Health Information Technology David K. Nace MD, Medical Director, McKesson Corporation Co-Chair,
More information4. Regularly participate in PCMH Initiative conference calls, webinars and in-person events.
1 PHYSICIAN ORGANIZATION (PO) RESPONSIBILITIES The PO is responsible for supporting with implementation of the PCMH Initiative, aiding participating Practices in their development of PCMH capabilities
More informationPBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts
PBGH Response to CMMI Request for Information on Advanced Primary Care Model Concepts 575 Market St. Ste. 600 SAN FRANCISCO, CA 94105 PBGH.ORG OFFICE 415.281.8660 FACSIMILE 415.520.0927 1. Please comment
More informationProviding and Billing Medicare for Chronic Care Management Services
Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) No portion of this white paper may be used or duplicated by any person
More informationPatient-Centered Medical Homes in Rural and Underserved Areas: A Webinar and Peer Discussion for Primary Care Offices
Patient-Centered Medical Homes in Rural and Underserved Areas: A Webinar and Peer Discussion for Primary Care Offices Association of State and Territorial Health Officials (ASTHO) August 17, 2016 Dial-In
More informationNote: Accredited is the highest rating an exchange product can have for 2015.
Quality Overview Accreditation Exchange Product Accrediting Organization: NCQA HMO (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product can have for 215.
More informationA legacy of primary care support underscores Priority Health s leadership in accountable care
Priority Health has been at the forefront of supporting primary care, driving accountability, improving quality and improving care for patients. A legacy of primary care support underscores Priority Health
More informationCentral Ohio Primary Care (COPC) Spotlight on Innovation
Central Ohio Primary Care (COPC) Spotlight on Innovation BY BETTER MEDICARE ALLIANCE MARCH 2017 Central Ohio Primary Care Spotlight on Innovation 1 Central Ohio Primary Care (COPC) Spotlight on Innovation
More informationConnecticut SIM: Enabling Accountable Care and Accountable Communities
Connecticut SIM: Enabling Accountable Care and Accountable Communities SIM SYMPOSIUM FROM ACCOUNTABLE CARE TO ACCOUNTABLE COMMUNITIES: HOW CONNECTICUT S STATE INNOVATION MODEL INITIATIVE IS DRIVING REFORM
More informationUnique Billing for PCMH Transition of Care/HCC Risk Management
THE MEDICAL HOME SUMMIT MARCH 23, 2015 Unique Billing for PCMH Transition of Care/HCC Risk Management JAYNE BRYANT RN, BSN THERESA BAILEY, LVN JAMES L. HOLLY, MD MARCH 23, 2015 Criteria for New Codes 2
More informationUsing Data for Proactive Patient Population Management
Using Data for Proactive Patient Population Management Kate Lichtenberg, DO, MPH, FAAFP October 16, 2013 Topics Review population based care Understand the use of registries Harnessing the power of EHRs
More informationPatient Centered Medical Home The next generation in patient care
Patient Centered Medical Home The next generation in patient care Provider Training Module I OBJECTIVE To explain... What Patient Centered Medical Home is How it works Why it s important Where to begin
More informationMichigan Primary Care Transformation (MiPCT) Project Frequently Asked Questions
Michigan Primary Care Transformation (MiPCT) Project Frequently Asked Questions Demonstration Design 1. What is the Michigan Primary Care Transformation (MiPCT) Project? The Centers for Medicare and Medicaid
More informationGoals & Challenges for Outpatient Quality Directors. Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE
Goals & Challenges for Outpatient Quality Directors Quality HealthCare Consulting, LLC CEO: Jennifer O'Donnell, MHA, PCMH-CCE Objectives Learn a practical way for Quality Directors to align Quality Measures
More informationapproved Nevada s State Innovation Model (SIM) Round October 2015 Division of Health Care Financing and Policy Introduction to SIM
Nevada State Innovation Model (SIM) October 2015 1 Introduction to SIM The Center for Medicare and Medicaid Services (CMS) approved Nevada s State Innovation Model (SIM) Round Two application to improve
More informationAccelerating the Impact of Performance Measures: Role of Core Measures
Accelerating the Impact of Performance Measures: Role of Core Measures Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair
More informationPaul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA
Paul Glassman DDS, MA, MBA Professor and Director of Community Oral Health University of the Pacific School of Dentistry San Francisco, CA What is Quality? Quality is a direct experience independent of
More informationPotential for an additional 5% PDCM-PCP BCBSM Value Based Reimbursement (VBR) onto your Patient Centered Medical Home designation VBR (estimated
Revised 1/25/2018 1 Potential for an additional 5% PDCM-PCP BCBSM Value Based Reimbursement (VBR) onto your Patient Centered Medical Home designation VBR (estimated average of $4,000 per physician, varies
More informationCoxHealth: A Case Study in Launching a Co-Branded Medicare Advantage Plan
CoxHealth: A Case Study in Launching a Co-Branded Medicare Advantage Plan Guiding a Health System s Journey to Value with a Collaborative Payer Partner Situation $1.3 billion, five-hospital system in the
More informationFrom Reactive to Proactive: Creating a Population Management Platform
Session D9 / E9 From Reactive to Proactive: Creating a Population Management Platform Richard Gitomer, MD Director, Brigham and Women s Primary Care Center of Excellence Vice Chair, Primary Care, Dept.
More informationProviding and Billing Medicare for Chronic Care Management
Providing and Billing Medicare for Chronic Care Management 2015 Medicare Physician Fee Schedule Final Rule November 2014 (PYA). No portion of this white paper may be used or duplicated by any person or
More informationMD, MBA, FACHE, FAAPL
Washington Association of Medical Staff Services Vancouver, Washington Ambulatory Credentialing and Privileging Jon Burroughs, MD, MBA, FACHE, FAAPL April 20, 2018 The Healthcare Transformation Journey:
More informationPatient-Centered. Medical Homes (Presentation Handout)
Patient-Centered Medical Homes (Presentation Handout) Presented to AFC SPC, 3/14/13 by Barbara Schechtman, MPH 1 What is a PCMH? From the March 2007 Joint Principles of the PCMH: AAP, American Academy
More informationThe influx of newly insured Californians through
January 2016 Managing Cost of Care: Lessons from Successful Organizations Issue Brief The influx of newly insured Californians through the public exchange and Medicaid expansion has renewed efforts by
More informationTable of Contents. Bellin Health Lessons from a Successful Medicare Pioneer ACO
Bellin Health Lessons from a Successful Medicare Pioneer ACO March 31, 2016 Table of Contents I. We Are Doing Some Good Things Rating Agency Actions II. Who We Are Bellin Health s Platform Organizational
More informationCPC+ CHANGE PACKAGE January 2017
CPC+ CHANGE PACKAGE January 2017 Table of Contents CPC+ DRIVER DIAGRAM... 3 CPC+ CHANGE PACKAGE... 4 DRIVER 1: Five Comprehensive Primary Care Functions... 4 FUNCTION 1: Access and Continuity... 4 FUNCTION
More informationKaiser Permanente QUALITY OVERVIEW OVERALL RATING : 3.4 COMPANY AT A GLANCE. Company Statistics. Accreditation Exchange Product
QUALITY OVERVIEW Permanente As the state s largest nonprofit health plan, Permanente is committed to improving the health of our members and our state as a whole. Permanente is made up of: Foundation Hospitals
More informationBlue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies
Blue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies Effective 2/4/2018 The following program policies are applicable to all contracted providers and practices recognized
More informationUnitedHealth Center for Health Reform & Modernization September 2014
Health Reform & Modernization September 2014 2014 UnitedHealth Group. Any use, copying or distribution without written permission from UnitedHealth Group is prohibited. Overview Why Focus on Primary Care?
More informationHumana Physician Quality Rewards Program 2014
Humana Physician Quality Rewards Program 2014 Medicare Glen Champlin MSO Director March 28, 2014 1430ALL0114-B What is CMS Stars and Why Should Providers Be Concerned? CMS Program of Quality & Performance
More informationInstitute for Healthcare Improvement Summit March 22, 2016 This presenter has nothing to disclose.
C7: How Value Based Care Can Improve Community Health David J. Bailey, MD, MBA President & CEO, Nemours Children s Health System Institute for Healthcare Improvement Summit March 22, 2016 This presenter
More informationWHAT IT FEELS LIKE
PCMH and PCSP WHAT IT FEELS LIKE Presentation Outline Goals of the Patient Centered Medical Home and the Patient Centered Specialty Practice Identifying the Joint Principles Recognition Programs Standards
More informationTexas ACO invests in the Quanum portfolio to improve patient care
Case study: Premier Management Company North Texas Texas ACO invests in the Quanum portfolio to improve patient care Premier Management Company (PMC) manages 3 accountable care organizations (ACOs) in
More informationPATH Program. Getting Started Guide
PATH Program Getting Started Guide We have a BIG opportunity. Together, we can empower and encourage people to take an active role in their health. Preventive health care services help people find and
More informationThought Leadership Series White Paper The Journey to Population Health and Risk
AMGA Consulting Thought Leadership Series White Paper The Journey to Population Health and Risk The Journey to Population Health and Risk Howard B. Graman, M.D., FACP White Paper, January 2016 While the
More informationBuilding & Strengthening Patient Centered Medical Homes in the Safety Net
Blue Shield of California Foundation County Coverage Expansion Planning Workshop #2 Building & Strengthening Patient Centered Medical Homes in the Safety Net July 8, 2011 Presented by: Kathryn Phillips,
More informationExhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013)
Exhibit 1. Medicare Shared Savings Program: Year 1 Performance of Participating Accountable Care Organizations (2013) 24 percent (52 ACOs) earned shared savings bonus 27 percent (60 ACOs) reduced spending,
More informationFriday Health Plans of Colorado
QUALITY OVERVIEW Health Plans of Colorado (formerly Colorado Choice Health Plans) Serving Colorado for over 4 years, Health Plans utilizes a community-focused model. We work hand in hand with local providers
More informationBlue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies
Blue Cross & Blue Shield of Rhode Island (BCBSRI) Advanced Primary Care Program Policies Effective 1/1/2016 The following program policies are applicable to all contracted providers and practices participating
More informationAdvanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum
Advanced Illness Management Leveraging Person Centered Care and Reengineering the Care Team Across the Continuum Betsy Gornet, FACHE Chief Advanced Illness Management Executive Sutter Health / Sutter Care
More informationTO BE RESCINDED Patient-centered medical homes (PCMH): eligible providers.
ACTION: Final DATE: 09/21/2018 3:40 PM TO BE RESCINDED 5160-1-71 Patient-centered medical homes (PCMH): eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model
More informationENGAGED LEADERSHIP. TC-02 (Core): Defines practice organizations structure and staff responsibilities/skills to support key PCMH functions.
Change Concepts for Practice Transformation AND 2014 NCQA PCMH Standards Crosswalk to 2017 NCQA Standards Change Concept Element 2014 NCQA PCMH Standards 2014 --> 2017 2017 NCQA Standards ENGAGED LEADERSHIP
More informationValue-Based Reimbursements are Here: Are you Ready?
Value-Based Reimbursements are Here: Are you Ready? White Paper ELLIS MAC KNIGHT, MD Senior Vice President/CMO Published by Becker s Hospital Review April 2016 White Paper Value-Based Reimbursements are
More informationReimagining PCMH Recognition
Reimagining PCMH Recognition August 2016 Michael S. Barr, MD, MBA, MACP Executive Vice President Quality, Measurement & Research Group Re-use without permission is prohibited 1 Where is PCMH in future
More informationState Leadership for Health Care Reform
State Leadership for Health Care Reform Mark McClellan, MD, PhD Director, Engelberg Center for Health Care Reform Senior Fellow, Economic Studies Leonard D. Schaeffer Chair in Health Policy Studies Brookings
More informationAnthem BlueCross and BlueShield HMO
Quality Overview BlueCross and BlueShield Accreditation Exchange Product Accrediting Organization: NCQA (Exchange) Accreditation Status: Accredited Note: Accredited is the highest rating an exchange product
More informationAccountable Care Collaborative: Transforming from Volume to Value
Accountable Care Collaborative: Transforming from Volume to Value Risk Segmentation and Modeling American Medical Group Association Gary Piefer, MD, MS, FAAFP, FACPE Thursday June 14, 2010 WellMed Agenda
More informationCROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS
CROSSWALK: CHANGE CONCEPTS FOR PRACTICE TRANSFORMATION AND 2014 NCQA PCMH TM RECOGNITION STANDARDS 1a. Provide visible and sustained leadership to lead overall cultural change as well as specific strategies
More informationProviding and Billing Medicare for Chronic Care Management Services
Providing and Billing Medicare for Chronic Care Management Services (and Other Fee-For-Service Population Health Management Services) Updated March 2018 No portion of this white paper may be used or duplicated
More informationRisk Adjusted Diagnosis Coding:
Risk Adjusted Diagnosis Coding: Reporting ChronicDisease for Population Health Management Jeri Leong, R.N., CPC, CPC-H, CPMA, CPC-I Executive Director 1 Learning Objectives Explain the concept Medicare
More informationPopulation Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson
Population Health and the Accelerating Leap to Outcomes-Based Reimbursement Craig J. Wilson Agenda / Goals Define Population Health Management Review emerging reimbursement landscape eg MACRA Review why
More informationImproving Patient-Centered Medical Home (PCMH) Recognition: Board-Endorsed Recommendations of the PCPCC Accreditation Work Group
Improving Patient-Centered Medical Home (PCMH) Recognition: Board-Endorsed Recommendations of the PCPCC Accreditation Work Group BACKGROUND: Patient-Centered Primary Care Collaborative November 2015 The
More information2019 Quality Improvement Program Description Overview
2019 Quality Improvement Program Description Overview Introduction Eon/Clear Spring s Quality Improvement (QI) program guides the company s activities to improve care and treatment for the member s we
More informationPharmacy Quality Measures. Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013
Pharmacy Quality Measures Presentation Developed for the Academy of Managed Care Pharmacy Updated: February 2013 Objectives Explain the purpose of quality measures and how they are developed Identify quality
More informationExamining the Differences Between Commercial and Medicare ACO Models
Examining the Differences Between Commercial and Medicare ACO Models Michelle Copenhaver December 10, 2015 Agenda 1 Understanding Accountable Care Organizations 2 Moving to Accountable Care: Enhancing
More informationpage 30 MGMA Connexion April MGMA-ACMPE. All rights reserved.
page 30 MGMA Connexion April 2013 Quality Management Deep dive: What lies beneath the surface? Reassessing your credentialing process could mean more money in your practice By Scott T. Friesen Effective
More informationState Innovation Model
State Innovation Model April 20, 2016 healthier and more productive lives, no matter their stage in life. 1 SIM Overview Overview and Vision Goals and Objectives Strategic approach for roll out Patient
More information2018 MGMA COST AND REVENUE SURVEY
(*Asterisks denote required questions) *Note: The Practice Profile must be completed before beginning any of the MGMA Surveys* Time is a valuable thing! We ve created a tiered participation benefit structure
More information2014 PCMH STANDARDS. Renewals & Annual Data Requirements
2014 PCMH STANDARDS Renewals & Annual Data Requirements PCMH Renewal Process Streamlined process for renewal through reduced documentation requirements. Even though some elements do not require documentation,
More informationImproving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations. April 26, 2018
Improving Care and Lowering Costs: The Use of Clinical Data by Medicaid Managed Care Organizations April 26, 2018 Agenda Welcome and Overview of Interview Results Claudia Ellison, Director of Programs,
More informationCoastal Medical, Inc.
A Culture of Collaboration The Organization Physician-owned group Currently 19 offices across the state of Rhode Island and growing 85 physicians, 101 care providers The Challenge Implement a single, unified
More informationMedicare Shared Savings ACOs: One Organization s Lessons Learned. Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP
Medicare Shared Savings ACOs: One Organization s Lessons Learned Gregory A. Spencer MD FACP Chief Medical Officer Crystal Run Healthcare LLP Learning Objectives Identify organizational strengths and weaknesses
More informationAnthem BlueCross and BlueShield
Quality Overview BlueCross and BlueShield Accreditation Exchange Product Accrediting Organization: Accreditation Status: NCQA Health Plan Accreditation (Commercial HMO) Accredited Accreditation Commercial
More informationGHS Department of Family Medicine Overview of Physician Compensation Plans
GHS Department of Family Medicine Overview of Physician Compensation Plans Sean T. Bryan, MD, FAAFP Susan Mullinax, MBA Chair, University Medical Group Board of Directors, Chair, Department of Family Medicine,
More informationA Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation
A Practical Approach Toward Accountable Care and Risk-Based Contracting: Design to Implementation Daniel J. Marino, President/CEO, Health Directions Asad Zaman, MD June 19, 2013 Session Objectives Establish
More informationAmbulatory Care Practice Trends and Opportunities in Pharmacy
Ambulatory Care Practice Trends and Opportunities in Pharmacy David Chen, R.Ph., M.B.A. Senior Director Section of Pharmacy Practice Managers ASHP Objectives Describe trends in health system pharmacy reported
More informationImplementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers
Implementing Medicaid Value-Based Purchasing Initiatives with Federally Qualified Health Centers Beth Waldman, JD, MPH June 14, 2016 Presentation Overview 1. Brief overview of payment reform strategies
More information10/10/2017. Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP
Mythbusters: Primary Care Edition (Expanding Opportunities) Amina Abubakar, PharmD, AAHIVP Olivia bentley, PharmD, CFts, AAHIVP 1 Disclosures Amina Abubakar, PharmD, AAHIVP, RX Clinic Pharmacy and Olivia
More informationValue-Based Payment Models, Questions for the Industry, Health Leader Media, Answers by James L. Holly, MD April 15, 2015
Value-Based Payment Models, Questions for the Industry, Health Leader Media, Answers by James L. Holly, MD April 15, 2015 Here is the List of 8 Leftover 5 for your consideration: Why is capitation with
More informationPatient-centered medical homes (PCMH): Eligible providers.
ACTION: Final DATE: 09/20/2016 8:11 AM 5160-1-71 Patient-centered medical homes (PCMH): Eligible providers. (A) A Patient-centered medical home (PCMH) is a team-based care delivery model led by primary
More informationDraft Covered California Delivery Reform Contract Provisions Comments Welcome and Encouraged
TO: FROM: RE: State Based Marketplaces State Medicaid Directors Delivery Reform/Value Promoting Colleagues Peter V. Lee, Executive Director Draft Covered California Delivery Reform Contract Provisions
More informationValue-Based Contracting
Value-Based Contracting AUTHOR Melissa Stahl Research Manager, The Health Management Academy 2018 Lumeris, Inc 1.888.586.3747 lumeris.com Introduction As the healthcare industry continues to undergo transformative
More informationThe Physician s Perspective
The Physician s Perspective How the Changing Role of the PCP is Leading Healthcare Reform May 22, 2015 Carman A. Ciervo, DO Chief Physician Executive Our Vision To transform the healthcare To transform
More informationGetting Started in a Medicare Shared Savings Program Accountable Care Organization
1 Getting Started in a Medicare Shared Savings Program Accountable Care Organization Tuesday, September 16 th Pam Maxwell, Chief Growth Officer What is an ACO? Accountable Care Organizations (ACOs) are
More informationColorado Choice Health Plans
Quality Overview Health Plans Accreditation Exchange Product Accrediting Organization: Accreditation Status: URAC Health Plan Accreditation (Marketplace ) Full Full: Organization demonstrates full compliance
More informationSharp HealthCare ACO. Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group
Sharp HealthCare ACO Presented by: Donald C. Balfour, M.D. President and Medical Director Sharp Rees-Stealy Medical Group Institute for Quality Leadership Annual Conference October 4, 2012 Sharp ACO Collaborations
More informationHEALTH CARE REFORM IN THE U.S.
HEALTH CARE REFORM IN THE U.S. A LOOK AT THE PAST, PRESENT AND FUTURE Carolyn Belk January 11, 2016 0 HEALTH CARE REFORM BIRTH OF THE AFFORDABLE CARE ACT Health care reform in the U.S. has been an ongoing
More informationPhysician Compensation Methodologies and Building Clinically Integrated Communities. Walter Kopp Medical Management Services
Physician Compensation Methodologies and Building Clinically Integrated Communities Walter Kopp Medical Management Services 1 Outline Analysis of Physician Compensation Methodology How compensation relates
More informationIntroducing AmeriHealth Caritas Iowa
Introducing AmeriHealth Caritas Iowa A presentation for Iowa providers. CPC; Q215 Iowa V1 Who We Are Who We Serve Agenda Our Mission AmeriHealth Caritas Iowa Why Partner With Us? Questions 2 2 Who We Are
More informationMedicare Plus Blue Group PPO. We have the solution.
Medicare Plus Blue Group PPO We have the solution. 1 What is Medicare Advantage? Plans offered by private insurance companies that contract with The Centers for Medicare and Medicaid Services (CMS). The
More informationGood day Chairpersons Gill and Vitale and distinguished committee members. Thank you for the
Written Testimony Before the New Jersey Senate Committee on Commerce and Committee on Health, Human Services and Senior Citizens Hearing on the OMNIA Health Alliance formed by Horizon Blue Cross Blue Shield
More informationGonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group
Gonzalo Paz-Soldán, MD, FAAP, CPE Executive Medical Director - Pediatrics Reliant Medical Group Describe the main characteristics of a PCMH Analyze potential benefits of becoming a PCMH Examine the criteria
More informationLONG TERM CARE INTEGRATION
LONG TERM CARE INTEGRATION Kristen D Smith, MPH Aging Program Administrator Aging & Independence Services County of San Diego Health and Human Services 1/11/2017 1 COUNTY OF SAN DIEGO Building Better Health
More informationChad Shearer, JD, MHA, Vice President for Policy, Medicaid Institute Director Misha Sharp, Research Analyst February 28, 2018
Testimony of the United Hospital Fund to the Council of the City of New York, Committee on Hospitals: Oversight Examining the Status of One New York: Health Care for Our Neighborhoods : What Progress Has
More informationMACRA, MIPS, and APMs What to Expect from all these Acronyms?!
MACRA, MIPS, and APMs What to Expect from all these Acronyms?! ACP Pennsylvania Council Meeting Saturday, December 5, 2015 Shari M. Erickson, MPH Vice President, Governmental Affairs & Medical Practice
More informationManaging Population Health in Northeast Georgia: One Medical Group's Experience
September 21, 2013 Managing Population Health in Northeast Georgia: One Medical Group's Experience By Mark Hagland Northeast Georgia Physicians Group (NGPG), based in Gainesville, Georgia, a suburb of
More informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More informationValue-based Purchasing: Trends in Ambulatory Care
August 17, 2011 The Tenth National Quality Colloquium Value-based Purchasing: Trends in Ambulatory Care Bettina Berman Project Director for Quality Improvement Jefferson School of Population Health Thomas
More informationBlue Quality Physician Program: Detailed Overview
2018 Blue Quality Physician Program: Detailed Overview Program Definition The Blue Quality Physician Program is comprised of many components with one purpose: improve the care and quality for our members.
More information